Comparison of TWO different postoperative analgesic methods in total knee artroplastia

Purpose: Although total knee replacement operation is an orthopedic surgery that is applied a lot, postoperative analgesia management is also very important in correlation with this frequency. There are many multimodal approaches for postoperative analgesia, and adductor canal block is a frequently used method among these approaches. In this study, it was aimed to investigate the effect of selective tibial block applied in addition to adductor canal block on postoperative analgesic consumption and visual analogue scores in TDP cases with combined spinal and epidural anesthesia. Materials and Methods: This randomized, prospective controlled study was conducted between May 2022 and December 2022 at the Ankara City Hospital Anesthesiology and Reanimation Clinic, after the approval of the Ankara City Hospital No. 1 Clinical Research Ethics Committee. A total of 76 ASA I-II-III patients aged 18-80 years who were planned to have primary unilateral TDP under combined spinal and epidural anesthesia were included in the study. The patients were randomly divided into two groups as Group A (adductor canal block) and Group AT (adductor canal block + selective tibial nerve block) using the closed envelope method. Adductor canal block was applied to Group A with 20 ml of 0.25% Bupivacaine under the guidance of USG. Under the guidance of USG, adductor canal block with 0.25% Bupivacaine and selective tibial nerve block with 0.25% Bupivacaine 20 ml were applied to Group AT. Patient-controlled analgesia device was applied to all patients in the postoperative period by setting them to bolus mode via epidural catheter. Postoperative 0-2-8-12-24th hour VAS scores of all patients were recorded. The amount of 24-hour PCA-mediated epidural analgesic consumption, the first consumption of additional analgesic, and the time were noted. Patient satisfaction and side effects were recorded. Results: 76 patients, including Group A 38 and Group AT 38 patients, were evaluated. In comparisons between groups; In terms of demographics, there was no statistically significant difference between the groups in terms of VAS values at the 0th, 1st, 2nd 8th, 12th and 24th hours postoperatively, the time of first additional analgesic administration in the postoperative period, side effect profile and patient satisfaction (p>0.05). In comparisons between groups; Postoperative 24-hour PCA device-mediated epidural analgesic drug consumption was found to be lower in Group AP (p<0.05). Conclusion: USG-guided Selective Tibial Block can be used as an alternative in combination for postoperative multimodal analgesia in TDP surgery. More studies are needed for stand-alone use.